Sophisticated bloggers can conceal patient identity.
I write a doctor's blog, and I post in the open (www.talesfromthewomb.blogspot.com). I write fictionalized medical events, discuss studies relevant to neonatal outcomes, and, on occasion, muddy myself with politics and evolution. I have not been afraid to take on controversy, but I am sensitive to the issue of patient confidentiality.
My policy is to never write about patients from my current place of work. When I write about events that were inspired by real patients, I create a new cast of characters and rewrite the scenario based upon a sentinel medical event that I want to explore. I do this from the point of view of a writer rather than a physician. I switch the times (referring to myself as a fellow rather than a resident, for example) and change the sex, race, cultural values, and religions of the families. I create a different cast of doctors and nurses. I also write from scratch without any access to patient notes or data.
Because I don't write about cases from my workplace, all of these cases are more than 8 years old. This allows me to explore the medicine and the ethics behind cased, without violating the trust of these patients. Sometimes, I use a case report in the literature or one that a colleague in another institution described at a medical meeting to create the vignette. I also never write about cases that are strikingly similar to those that I've cared for at my current institution. When you are out in the open, there is simply too much opportunity for people to think you might be writing about them. For me, being out in the open ensures a certain standard of ethics.
Others blog anonymously. I know some of these bloggers and they live in fear of being discovered. I think anonymous blogging is a reasonable way to protect patient confidentiality, but some people are better than others at writing in ways that don't give out identifying information.
Anonymous blogs can also be a way for doctors to speak up about their own rights. In one case, an anonymous blogger revealed that an institution was regularly violating work hour rules. We need to know what's going on in some of these hard-core programs, and anonymous blogging may be the only way we will ever truly know.
DR. GORDON is director of the neonatal and department of pediatrics fellowship programs at the University of Virginia Children's Hospital, Charlottesville.
PHILLIP V. GORDON, M.D., PH.D. …